Acute care among asthma patients using budesonide/formoterol or fluticasone propionate/salmeterol.
BACKGROUND
The combination of inhaled corticosteroids and long-acting inhaled beta(2)-adrenergic-agonists has become the standard therapy for many patients with moderate to severe persistent asthma. Whether the differences between budesonide/formoterol and fluticasone/salmeterol translate into differences in treatment outcomes in a real life setting is unknown.


OBJECTIVE
This study compared the use of healthcare services between new users of budesonide/formoterol and fluticasone/salmeterol in a single inhaler between 2002 and 2004.


METHODS
A 12-month population-based retrospective cohort study using administrative health care databases was conducted. Asthma patients 16-65 years of age using budesonide/formoterol were matched according to age and markers of asthma severity to patients using fluticasone/salmeterol. The rate of emergency department (ED) visits for asthma, hospitalizations for asthma, claims for oral corticosteroids, and visits to a respiratory specialist were compared between the two groups using Poisson regression models. The mean number of doses of short-acting beta(2)-adrenergic-agonists (SABA) per week was compared between the two groups using a linear regression model.


RESULTS
Users of budesonide/formoterol were found to be less likely to have an ED visit for asthma (adjusted RR=0.72; 95% CI: 0.54-0.96), a hospitalization for asthma (adjusted RR=0.50; 95% CI: 0.25-0.99), a claim for oral corticosteroids (adjusted RR=0.83; 95% CI: 0.72-0.95), and use SABA (adjusted mean difference=-1.1 dose per week; 95% CI: -1.7; -0.5) than patients treated with fluticasone/salmeterol.


CONCLUSIONS
Our study has found that subjects initiating ICS/LABA treatment with budesonide/formoterol had better outcomes than those initiating treatment with fluticasone/salmeterol.
Blais
Lucie
L
Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada. lucie.blais@umontreal.ca
Beauchesne
Marie-France
MF
Forget
Amélie
A
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000730:Androstadienes / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D019819:Budesonide / Q000008:administration & dosage*; D016022:Case-Control Studies; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000008:administration & dosage*; D005260:Female; D000068298:Fluticasone; D000068759:Formoterol Fumarate; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010349:Patient Compliance / Q000706:statistics & numerical data; D012189:Retrospective Studies; D000068299:Salmeterol Xinafoate; D055815:Young Adult
D000730:Androstadienes; D001993:Bronchodilator Agents; D004983:Ethanolamines; D019819:Budesonide; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D000420:Albuterol; D000068759:Formoterol Fumarate